Ambulatory Cardiac Monitoring for Discharged Emergency Department Patients with Possible Cardiac Arrhythmias

Abstract

IntroductionMany emergency department (ED) patients have symptoms that may be attributed to arrhythmias, necessitating outpatient ambulatory cardiac monitoring. Consensus is lacking on the optimal duration of monitoring. We describe the use of a novel device applied at ED discharge that provides continuous prolonged cardiac monitoring.MethodsWe enrolled discharged adult ED patients with symptoms of possible cardiac arrhythmia. A novel, single use continuous recording patch (Zio®Patch) was applied at ED discharge. Patients wore the device for up to 14 days or until they had symptoms to trigger an event. They then returned the device by mail for interpretation. Significant arrhythmias are defined as: ventricular tachycardia (VT) ≥4 beats, supraventricular tachycardia (SVT) ≥4 beats, atrial fibrillation, ≥3 second pause, 2nd degree Mobitz II, 3rd degree AV Block, or symptomatic bradycardia.ResultsThere were 174 patients were enrolled and all mailed back their devices. The average age was 52.2 (± 21.0) years, and 55% were female. The most common indications for device placement were palpitations 44.8%, syncope 24.1% and dizziness 6.3%. Eighty-three patients (47.7%) had ≥1 arrhythmias and 17 (9.8%) were symptomatic at the time of their arrhythmia. Median time to first arrhythmia was 1.0 days (IQR 0.2–2.8) and median time to first symptomatic arrhythmia was 1.5 days (IQR 0.4–6.7). 93 (53.4%) of symptomatic patients did not have any arrhythmia during their triggered events. The overall diagnostic yield was 63.2%ConclusionThe Zio®Patch cardiac monitoring device can efficiently characterize symptomatic patients without significant arrhythmia and has a higher diagnostic yield for arrhythmias than traditional 24–48 hour Holter monitoring. It allows for longer term monitoring up to 14 days.

Wireless electrocardiographic monitoring in veterinary medicine

“…It can be used during various activities and for prolonged cardiac monitoring having therefore a high diagnostic yield and a high patient compliance. It can exceed and could thereby replace conventional Holter monitoring in human patients [5,7,12]. A more definite comparison of the new ECG monitor with a reference device in a larger population of animals is pending.…”

“…Beside the wearing comfort, which is achieved by reducing the number and length of the wires, these devices have very high reliability [1,2,3,4,5,6,7]. In human medicine supporting clinical validation data on wireless body electrodes grow [1,5,6,7,8,9,10,11,12], but in veterinary medicine this is to our knowledge the first report of the ECG data obtained in animals with a wireless body electrode attached to the skin and connected to a smart phone (tablet) via low power Bluetooth technology. The aim of these pilot measurements was to find out whether the limitations of the conventional Holter monitoring could be surmounted.…”

Diagnostic yield of an ambulatory patch monitor in patients with unexplained syncope after initial evaluation in the emergency department: the PATCH-ED study

“…Although ambulatory ECG monitoring has been studied in an ED population before,16 and in other emergency presentations,17 18 this is the first study using ambulatory ECG solely in patients presenting to the ED with syncope and also the first fitting the monitor at the time of the index presentation. This strategy has the potential to change current management of syncope patients by reducing hospital admissions, changing first-line monitoring from low diagnostic yield Holter to higher yield patches and allowing earlier diagnosis and treatment of clinically important arrhythmias in turn reducing morbidity and increasing quality of life.…”

2017 ISHNE-HRS expert consensus statement on ambulatory ECG and external cardiac monitoring/telemetry

“…Thus, information about the burden of AF cannot be consistently ascertained. Patch monitors and MCT are the most complete outpatient ECG recording and increase the likelihood for detecting AF, and can provide accurate representation of AF burden for the duration of recording (Barrett et al, 2014;Rosenberg et al, 2013;Rothman et al, 2007;Turakhia et al, 2013;Schreiber et al, 2014).…”